Hypoglycemia-Induced Blood Pressure Elevation in Patients With Diabetes

Feldman–Billard, S.

doi:10.1001/archinternmed.2010.98

Cited by 30 publications

(19 citation statements)

References 10 publications

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“…By using continuous glucose monitoring system and 24-hour electrocardiographic monitoring, a close temporal relationship can be found between hypoglycemia and elevated blood pressure; nocturnal hypoglycemia is found to be associated with QTc prolongation and cardiac rate/rhythm disturbances in ambulant patients with T1DM 89,90. Since cardiovascular disease and all-cause mortality is closely linked to elevated blood pressure, increased blood pressure variability and recurrent rises blood pressure post-hypoglycemia episode may be of concern 91…”

Section: Cardiologymentioning

confidence: 99%

Hypoglycemia Revisited in the Acute Care Setting

et al. 2011

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Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic complications and even death, and further preclude maintenance of euglycemia over a lifetime of diabetes. Recent studies have shown that hypoglycemia is associated with adverse outcomes in many acute illnesses. In addition, hypoglycemia is associated with increased mortality among elderly and non-diabetic hospitalized patients. Clinicians should have high clinical suspicion of subtle symptoms of hypoglycemia and provide prompt treatment. Clinicians should know that hypoglycemia is associated with considerable adverse outcomes in many acute critical illnesses. In order to reduce hypoglycemia-associated morbidity and mortality, timely health education programs and close monitoring should be applied to those diabetic patients presenting to the Emergency Department with SH. ED disposition strategies should be further validated and justified to achieve balance between the benefits of euglycemia and the risks of SH. We discuss relevant issues regarding hypoglycemia in emergency and critical care settings.

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Section: Cardiologymentioning

confidence: 99%

Hypoglycemia Revisited in the Acute Care Setting

et al. 2011

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“…The SEARCH study has also described elevated inflammatory markers even in youth with type 1 diabetes and good metabolic control compared with control subjects, suggesting an explanation for accelerated atherosclerosis in type 1 diabetes (14). In addition, Feldman-Billard et al (15) described hypoglycemia-induced hypertension in a group of diabetic patients. If hypoglycemia acutely provokes intense changes in hemodynamics and several hemorheological parameters, it could play a different role in atherosclerosis when chronically repeated.…”

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confidence: 99%

Repeated Episodes of Hypoglycemia as a Potential Aggravating Factor for Preclinical Atherosclerosis in Subjects With Type 1 Diabetes

et al. 2010

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OBJECTIVETo evaluate through early preclinical atherosclerosis assessment whether repeated episodes of hypoglycemia represent an aggravating factor for macrovascular disease in type 1 diabetes.RESEARCH DESIGN AND METHODSAfter sample-size calculation, a case-control study of 25 patients with type 1 diabetes and repeated severe/nonsevere hypoglycemia (H-group) compared with 20 age- and sex-matched type 1 diabetes control subjects (C-group) was designed. Assessment of preclinical atherosclerosis consisted of flow-mediated brachial dilatation (FMD) and carotid and femoral intima-media thickness (IMT) studies. To consider hypoglycemia awareness, two different questionnaires and symptomatic response to an acute induction to hypoglycemia were used. Evaluation of the glycemic profile was obtained from continuous glucose monitoring. Endothelial function/inflammation markers were measured in euglycemia/hypoglycemia. A multivariate linear regression analysis was performed to test whether repeated hypoglycemia was independently associated with atherosclerosis.RESULTSH-group subjects displayed hypoglycemia unawareness and presented a higher percentage of continuous glucose values and area under the curve <70 mg/dl compared with the C-group (14.2 ± 8.9 vs. 6.3 ± 7.1%, P < 0.02 and 2.4 ± 1.8 vs. 0.6 ± 1.0 mg/dl/day, P < 0.01). The percentage of maximal FMD was lower in the H-group than in the C-group (6.52 ± 2.92 vs. 8.62 ± 3.13%, P < 0.05). A significantly higher IMT was observed at both carotid and femoral sites in the H-group (carotid 0.53 ± 0.09 vs. 0.47 ± 0.08 mm, P < 0.05 and femoral 0.51 ± 0.17 vs. 0.39 ± 0.09 mm, P < 0.05). Baseline inflammation and endothelial function markers were higher in the H-group (leukocytes 7.0 ± 1.8 vs. 5.6 ± 1.4 × 103/ml, von Willebrand factor 119 ± 29 vs. 93 ± 26%, fibrinogen 2.82 ± 0.64 vs. 2.29 ± 0.44g/l, and soluble intercellular adhesion molecule-1 408 ± 224 vs. 296 ± 95 ng/ml; P < 0.05 for all).CONCLUSIONSIn addition to the induction of hypoglycemia unawareness and an increased risk for severe hypoglycemia, repeated hypoglycemia could be related to and considered an aggravating factor for preclinical atherosclerosis in type 1 diabetes. The precise mechanisms explaining this association remain to be clarified.

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“…Moreover, other factors than BP may influence retinal thickness, such as hypoglycaemic events (Feldman‐Billard et al. , ), hormonal fluctuations and body position (Polito et al. ).…”

Section: Discussionmentioning

confidence: 99%

Influence of pulse pressure and spontaneous variations of macular thickness in patients with diabetic macular oedema

Dupas

Feldman–Billard

Quoc

et al. 2014

Acta Ophthalmologica

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ABSTRACT.Purpose: To study spontaneous variations of central macular thickness (CMT) and its relation to blood pressure (BP) in patients with diabetic macular oedema (DME). Methods: 23 diabetic patients presenting with DME with a CMT ≥ 260 lm on optical coherence tomography (OCT-3, Carl Zeiss Meditec, CA) were followed every 2 weeks for 3 months. At baseline, ambulatory 24H-BP monitoring (ABPM) was performed, as well as five CMT measurements (9 am, 12 am, 3 pm, 6 pm and 9 am the day after). During follow-up, BP and CMT were simultaneously measured at 9 am. Results: Significant spontaneous variations in CMT (at least one change in CMT greater than 11% compared to the median CMT value) were observed over 3 months in 48% of patients. Mean CMT decreased over the day and increased during the night, but not significantly (p = 0.1). During the 6 visits, the CMT at 9 am positively correlated with the pulse pressure (PP) measured at the same time (r = 0.29, p = 0.0008). In addition, the mean 24H-CMT was positively correlated with the mean 24H-PP (r = 0.48, p = 0.02). Conclusion: Significant spontaneous changes in CMT of patients with DME were observed in nearly half of cases over 3 months. Retinal thickness was correlated to PP levels (patients with higher CMT had higher PP levels). This high variability of macular oedema, and the influence of BP on retinal thickness, should be taken into consideration by practitioners when evaluating the benefit of a therapy in DME.

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Hypoglycemia-Induced Blood Pressure Elevation in Patients With Diabetes

Cited by 30 publications

References 10 publications

Hypoglycemia Revisited in the Acute Care Setting

Hypoglycemia Revisited in the Acute Care Setting

Repeated Episodes of Hypoglycemia as a Potential Aggravating Factor for Preclinical Atherosclerosis in Subjects With Type 1 Diabetes

Influence of pulse pressure and spontaneous variations of macular thickness in patients with diabetic macular oedema

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